Should We Be Screening for Colorectal Cancer Earlier?

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For a few weeks last month, Washington DC’s National Mall was lined with rows of blue flags— 27,400 of them, to be exact. The eerily beautiful display pulled together by the non-profit Fight Colorectal Cancer was actually a representation of a grim statistic: the flags symbolized the number of people under 50 projected to be diagnosed with the disease in 2030. According to the American Cancer Society, it already is, in 2023, the leading cause of cancer deaths in men under 50 and second among women the same age.

In fact, the incidence of younger-onset cancers (Kate Middleton is the latest famous name) seems to be growing broadly. Simone Ledward-Boseman is the widow of actor Chadwick Boseman, who died from the disease in 2020 at 43 (after being diagnosed at 39). She has since then made it her mission to spread awareness about the lifesaving importance of early screenings. At a Dana Farber Cancer Institute event she said: “Colorectal cancer is killing young people across the country, and most are vastly underestimating their risk. I’ve seen how this disease moves, and I now know how treatable it is when detected early.”

Reading between the numbers

Earlier this year, the World Health Organization announced that globally, cancer cases are expected to increase 77% by 2050. William L. Dahut, MD, chief scientific officer at the American Cancer Society, says this rise, while significant, can be attributed in great part to the growth and aging of the population. But, while the overall number of colorectal cancers have declined over time, there has been a marked uptick among those under 50. A recent JAMA study found that it is now the most common cancer for people under age 50, with one in five new cases occurring in those under 55.

The risk is higher for men than women (Dr. Dahut says men are 33% more likely to be diagnosed) and among Black and AI/AN (American Indian/ Alaskan Native) populations. The latter reflects differences in the availability of care. “There’s a huge component of systemic racism and inequity in terms of health care access and utilization,” says Yuying Luo, MD, assistant professor of medicine at Mount Sinai West and Morningside. And, adds Dr. Dahut, that has meant that people with the lowest socioeconomic status are about 40% more likely to be diagnosed with colorectal cancer than those at the highest end.

Another reason to eat your vegetables

While the precise reasons the rates of colorectal cancer are climbing are yet to be fully understood, there are a number of factors, says John Whyte, MD, MPH, chief medical officer for WebMD, that are thought to contribute. “Diets high in red and processed meats, excess alcohol consumption, and a sedentary lifestyle have been linked to an increased risk,” says Whyte. “Rising obesity rates among younger people may play a significant role. We know obesity promotes chronic inflammation, which increases cancer risk.”

Recent buzz around GLP-1 weight loss drugs (like Ozempic and Wegovy) is that they could prove beneficial for lowering colorectal cancer risk. Dr. Luo is often asked by patients about what comprises a solid GI diet, and her answer is always the same: one akin to the Mediterranean diet that is rich in vegetables and plant-based foods, and low in red meat and processed foods; plenty of fiber; alcohol in moderation; and diversity. “It’s important not to be eating the same thing every day,” she adds. That’s for the health of your microbiome.

Regular physical activity to counter all that time we log at our desks and on our sofas can help in that regard, too. “Physical activity improves gut health and reduces inflammation,” says Whyte. “By increasing gut diversity, you decrease the number of harmful bacteria that promote cancer cell formation.”

Have the talk

We know we’re not supposed to bring up religion or politics (especially this election year) around the family table, so how about talking about colon history instead? It’s just as uncomfortable but the outcome may actually be helpful. Talking to your family about their medical history is so important, says Dr. Luo, because the disease has a genetic component.

“Do polyps run in the family? Does inflammatory bowel disease run in the family because that increases the risk,” says Dr. Luo. Sharing family history with your doctor will help them determine when and what type of screening you need. Also, be mindful of any changes in your own body like shifting bowel habits (constipation? diarrhea?), blood in your stool, unexplained weight loss, or persistent abdominal discomfort. If you see something, say something. Dr. Luo adds that iron deficiency is also a tell-tale sign for her that there may be something amiss.

Screen, screen, screen

While the numbers feel staggering, it’s important to remember that the risk remains relatively low. What’s crucial in curbing the rates of colon cancer diagnoses is making screenings available for everyone who needs one. “Screening is the most important preventative for colorectal cancer,” says Dr. Dahut. And it’s only good if you do it early, adds Dr. Luo.

A colonoscopy remains the gold-standard screening method. That’s where a flexible tube with a camera is inserted in your rectum to search for polyps or detect cancer, usually while under sedation. If the doctor finds polyps (benign growths of tissue) they can be removed during the procedure. (That's something, Dr. Luo says, happens 30% of the time.) The biggest drag is the day-of prep it requires (lots of laxatives and lots of hours spent on the toilet), but the procedure itself is usually quick and painless.

Then there are stool-based tests like FIT or gFOBT or Cologuard, which involve collecting poop in a box and shipping it off for analysis, or, as of this year, a pricy home blood test by Guardant that looks for DNA fragments from tumor cells. But while these can sometimes catch advanced polyps, says Dr. Luo, they’re not ideal for spotting the early-stage ones. “They’re not what I would say is a colon cancer prevention tool because their goal is to catch stage one, two, and three colon cancer, no small polyps,” she adds. The goal of colonoscopies is not to find cancer but to find and remove polyps before they potentially turn into it.

If not now, when?

The US Preventive Services Task Force recommends that most people begin getting regular screenings at 45. If you have a family history of colorectal cancer or another genetic predisposition, then your doctor may advise you to start as early as 40. But if the numbers of young people getting diagnosed are on an upswing, should we all be getting screened earlier?

There is a growing debate around lowering the age for routine screenings, says Dr. Whyte, though he adds that insurance coverage and recommendations lag behind the latest research and trends. What may be more critical than lowering it is ensuring that everyone, no matter what their socioeconomic background, has access to screenings by the current recommended age. “We need to do a much better job in terms of addressing health care disparities," says Dr. Luo. "In terms of both access to colonoscopy screenings and for diagnostic testing.”

Originally Appeared on GQ